Hair Removal with 755 nm Alexandrite Laser via Subcutaneous Route in Stage-III Ear Reconstruction by Expansion

Congenital microtia reconstruction often introduces unwanted hair onto the new auricle. Laser hair removal can address this issue, but conventional external treatments require multiple sessions, increasing the overall treatment time, discomfort, and cost. Preclinical studies suggest that delivering laser energy from the flap's underside may improve efficiency by directly targeting hair follicles. We evaluated an intraoperative subcutaneous laser depilation approach applied during stage-III surgery to improve hair removal in this setting.

A prospective cohort study included 44 microtia patients undergoing stage-III auricular reconstruction. 23 patients received an intraoperative 755 nm Alexandrite laser via subcutaneous route during surgery, while 21 patients had a standard external laser session one week before surgery. Laser settings were adjusted for each: subcutaneous treatments used 10-12 J/cm² with 3 ms pulses, versus 14-20 J/cm² with 20 ms pulses externally. Hair counts per cm² were measured before treatment and two months after. Percentage hair reduction, complications, and patient satisfaction were compared between groups, with P < 0.05 considered significant.

Both methods produced significant hair reduction at 2 months. The subcutaneous group achieved 48.3% mean hair count reduction versus 44.7% in the epidermal group (P < 0.001). The subcutaneous approach required lower laser fluence (11.04 vs 16.29 J/cm², P < 0.001). No laser-related complications were observed. Patient satisfaction was high in both groups.

Intraoperative subcutaneous 755 nm Alexandrite laser depilation integrated into stage-III ear reconstruction appeared to be a safe and effective approach for reducing hair on the reconstructed auricle. Compared with conventional preoperative external laser treatment, this method showed a trend toward greater hair reduction while using lower fluence. This technique may reduce the need for multiple separate laser sessions and improve patient convenience.

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